Medial Malleolar Fracture Fixation with Stainless Steel, Titanium, Magnesium, and PLGA Screws: A Finite Element...

Implant material may influence interfragmentary mechanics in medial malleolar (MM) fracture fixation. This study aimed to compare stainless steel, titanium, magnesium, and PLGA screws under identical conditions using finite element analysis (FEA).

A CT-based ankle model with a unilateral oblique MM fracture (θ = 60° to the medial tibial plafond) was fixed with two parallel M4 × 35 mm screws placed perpendicular to the fracture plane (inter-axial distance 13 mm). Contacts were defined as nonlinear frictional, and each screw was assigned a pretension force of 2.5 N. Static single-leg stance was simulated with physiologic tibia/fibula load sharing. Four scenarios differed only by screw material. Primary outputs were interfragmentary micromotion (maximum sliding and gap). Secondary measures included fracture interface contact/frictional stresses, screw/bone von Mises stress, global construct displacement, and average tibiotalar cartilage contact pressure.

Interfragmentary micromotion increased as screw stiffness decreased. Maximum sliding was 32.2-33.8 µm with stainless steel/titanium, 40.4 µm with magnesium, and 65.0 µm with PLGA; corresponding gaps were 31.2-32.0 µm with stainless steel and titanium, 31.2 µm with magnesium, and 54.1 µm with PLGA, respectively. Interface stresses followed the same pattern: contact pressure (3.18-3.24 MPa for stainless steel/titanium/magnesium vs. 4.29 MPa for PLGA); frictional stress (1.46-1.49 MPa vs. 1.98 MPa). Peak screw von Mises stress was highest in stainless steel (104.1 MPa), then titanium (73.4 MPa), magnesium (47.4 MPa), and PLGA (17.9 MPa). Global axial displacement (0.26-0.27 mm) and average tibiotalar cartilage contact pressure (0.73-0.75 MPa) were essentially unchanged across materials. All conditions remained below commonly cited thresholds for primary bone healing (gap < 100 µm); however, PLGA exhibited a reduced safety margin.

Under identical geometry and loading conditions, titanium and stainless steel yielded the most favorable interfragmentary mechanics for oblique MM fixation; magnesium showed intermediate performane, and PLGA produced substantially greater micromotion and interface stresses. These findings support the use of metallic screws when maximal initial stability is required and suggest that magnesium may be a selective alternative when reducing secondary implant removal is prioritized.